Charlie M. Wray, DO, MS
@WrayCharles
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Assoc Prof of Med @UCSF | #HSR Investigator & Hospitalist @SFVAMC | Senior Deputy Editor @JHospMedicine | Co-director of SFVA @qualityscholar program
San Francisco, CA
Joined December 2013
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Pinned Tweet
1/ Here by popular demand “How to Publish in Academics When Publishing Isn’t Your Thing”.
A
#Tweetorial
on the picking & publishing low-hanging fruit in academic medicine.
Further input always welcome. By no means complete. Hope it helps. Thread…
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I'm not sure some of you understand...
When people who spent years working 80-100 hr weeks, missed large sections of their lives b/c of their jobs, & deal with life/death on daily basis say that COVID is hardest thing they've ever dealt with...
that should mean something to you
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My wife (a pediatrician) is staying late tonight at work to give families a chance to get their kiddos vaccinated after hours.
I picked up a few things for her for when she gets home.
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Inpatient medicine things I've learned over the years:
1. never interrupt nursing sign out
2. let the patient sleep
3. notes aren't that important
4. Let people call you by your first name
5. rounds should be done by lunch
6. respect every member of your team
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The absolute best way to find an error in a manuscript is to submit it to a journal then reread it 10min later...
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My hospital has an on-sight daycare.
Few things make me smile quicker than when I see a gaggle of 5 year olds holding onto a rope, wandering around our beautiful campus.
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Not sure who needs to hear this, but your success as a doctor is not defined by where you went to medical school or did residency
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Things I've Learned to Not Be Mad About in Hospital Medicine Over The Years:
- ED admissions w/no labs (I trust them)
- Taking any Ortho patient (not their job to know med)
- Social admits (they still need us!)
- Angry patients (I get it)
- Not knowing the answer to something
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1/ A short
#Tweetorial
on how to (not) present a “busy” PowerPoint slide. The “Where’s Waldo?” of Academic Medicine.
We’ve all seen it, and we all grumble about it, but how can we do better? Here are a few pointers I've seen and received over the years...
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Inpatient Teaching Tip
#467
:
If your patient is >90 years old, your primary goal should be to get them out of the hospital as fast as possible
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What’s something about your job that patients assumes you know how to do, but you have no idea how to do…?
For me, as a hospitalist, it’s turning off IV alarms
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My son: Dad, my allergies are acting up. Can I have some Zyrtec?
Me: Some what?
Son: Zyrtec
Me: I'm not following you...
Son: Ugggggg. Some cetirizine, Dad
Me: Sure thing, son
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I’m really concerned that
#MedTwitter
has normalized that the only way you can advertise where you matched is if it’s at an ivory tower.
Let’s not set that standard and exclude the vast majority of smart doctors who matched at other great programs.
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Proud dad moment: my son's teacher told me how he's been helping other kids in his class when they've struggled how kind he's been.
I'm headed to pick him up from school & take him for a treat & remind him that that's stuff is more important than getting his math homework right.
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Dear Journal Editor who rejected my paper in <24 hours. Thank you.
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Dear Medical Journals,
For the love of all that is holy, can we just have one universal format for initial submissions!? I promise to jump through all the other little hoops once it's accepted. Please...
Love,
Charlie
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Still trying to sit down in one sitting to "write a paper" or "complete a project". Don't.
Instead, harness the power of incrementalism.
One of the most valuable concepts I've discovered in my career
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Son: Hey Dad! What’s this?
Me: Torsades?
Son: Nope. Shark’s teeth.
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Does anybody else remember when we just called it systolic or diastolic dysfunction?
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This is my annual reminder...
If you listen closely. Tonight at 2AM you will hear a reverberating F#*K emanating from all teaching hospitals as residents have to endure an extra hour on call.
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Since its inception in 1812, this is only the 4th time an editorial has been collectively signed by the entire NEJM Editorial Board.
That should tell you something about how the medical community views the nations current leadership around
#COVID
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Attendings: what do you do to humanize yourself to your team and/or learners?
I like to drop a cuss word every once in a while. Usually catches everyone off guard, but also lightens the mood and leads to knowing nods and laughter
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How I rationalize my
#WorkLifeBalance
:
If 30 years from now I have 5 fewer publications and 3 fewer awards, but have helped my 2 sons become good, honest men...well then, I made the right choices
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Sad day in medical therapeutics, folks. My 4-year old told me my kisses no longer help his boo-boos.
This is the equivalent of cardiologist loosing lasix
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My goal in life is not to be the academic physician who also has a family, but rather the great father and husband who happens to be an academic physician
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My physician friends who view their work purely as a "job" seem to be the happiest & most content in life.
Has the labeling of a career in medicine as a "calling" contributed to the burnout and exhaustion* we see in the field?
(*yes, lots of other things contribute too)
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Are you better off being taken care of by an MD or DO?
@jbcarmody
& I had the honor to discuss the recent
@AnnalsofIM
paper that found no differences in 30-day mortality,🏥 readmissions, LOS, or health care costs between MD and DO's...
A quick 🧵...
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Manuscript under review for ~1 year
Reviewer: You should redo the whole analysis with more recent data
me:
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The evolution of medical skepticism:
As a medical student: I believed everything my attending said...
As a resident: believed every article I read...
As an attending: have no idea who or what to believe...
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Yesterday, my youngest son was having a temper-tantrum and nothing seemed to calm him down.
So, like any good hospitalist, I just pulled out my rounding list and started telling him about the patients.
Worked like a charm.
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They finished 4-years of undergrad, 4-years of medical school, endured 3-7 years of residency (some going on to get other degrees!), work 50-90 hrs a week...
and you still can't call female physicians "Doctor" when you email or send them a message?
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I find it ironic and sad that I have the power to give my hospitalized patients some extremely dangerous medications, but can’t get them pancakes when that’s all they really want for breakfast...
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It's 'Letter of Recommendation (LOR) season' in academic medicine!
Yes, they can take time, but here's a template I send to all requesters to help me formulate the best possible letter. Hope it's helpful for others!
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Five hours of Zoom meetings is worse than a 12-hour clinical shift.
I will die on this hill
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Academic success = writing 4 paragraphs on a manuscript and only deleting 3 of them at the end of the day
@AcademicsSay
@medicalaxioms
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No physicians mix ginger ale and cranberry juice to make a late-night (in-hospital) cocktail
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My neighborhood has started a tradition. At 8pm every night, everyone comes outside and howls in support of first responders and medical professionals. Couldn’t help but share...
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I’m gonna be honest, I like waving at the end of zoom calls
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For all those who matched, don’t forget to email your LOR writers to let them know where you’re heading.
Your successes mean a lot to us and we want to bask in your glory just a little bit
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I'm putting together a talk: "How To Publish When Publishing Isn't Your Thing".
Targeting those whose primary goal isn't a research career, but still recognize that you have to produce in some fashion
Appreciates thoughts and suggestions around this topic...
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If you listen closely, tonight at 2 AM as clocks roll back an hour, you will hear all on-call residents yell “F#*ck!!”
#DaylightSaving
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It’s my opinion that when a 91 year old patient (who is clinically stable) tells you they’re “ready to go home”, you move earth and heaven to make it happen
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@adamcifu
If they’ve made it that far I think I’d be soliciting recommendations from them, Adam
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If you can’t speak English, your odds of dying from sepsis are 31% higher than if you could. This blows my mind on so many levels!
Really interesting work from
@UCSF
’s
@zacharygjacobs
&
@KKangelaris
Does Limited English Proficiency (LEP) convey a greater odds of death in patients hospitalized for sepsis?
@ZacharyGJacobs
@KKangelaris
@UCSFDHM
@UCSFHospitals
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"Academia rewards those who can make hardship invisible, who can be productive amid and despite crisis"
A poignant & powerful piece via
@klharrisonPhD
on how Academia can do better around bereavement & loss
(IMHO, ideas here could apply to other areas)
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A word of advice:
Before you submit a manuscript, always print it out and read it. You'll be surprised by what you find.
Then, wait 2-3 days and do it again. Again, you'll be surprised by what you're able to improve upon.
Time and distance can be fantastic proof-reader
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In March 2020, I told my wife I wasn’t going to cut my hair until I received a vaccine. Today, she is doubly happy
#IGotTheShot
#Moderna
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My wife and I finally decided that I could have the spare bedroom as an office. Within 15 min of starting work today, my co-workers moved in…
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Does anyone else just want to walk over and give
@PeterHotez
a hug, or is it just me?
So thrilled to join Houston Mayor
@SylvesterTurner
ahead of this morning’s Thanksgiving Parade, ready for a little rain!
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One EHR system for the nation. Can you imagine the time, cost, and resource savings that would be attained for both providers and patients...
If you could do just one thing to improve US healthcare—what would it be?
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Dear learners-
I would rather you put your nickel down on the diagnosis and/or treatment and be wrong, than you equivocating on the variety of things that could be happening with the hopes that the right answer is buried in there.
Signed,
Your attending
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Whoever said
#DaylightSavingTime
gives you an extra hour of sleep didn’t have young children. See you all at 5:30AM...
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If anyone ever wanted to create an Escape Room in which doctors could never get out, all they’d have to do is place a beeping IV pump in there...
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I’ve had an manuscript that’s been rejected more times than I can recall...
Out of spite for the whole system, I’m on the verge of starting my own journal.
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The future of poster presentations is officially here...
Now that’s how to print a poster. Big font for conclusion. Data available (but smaller) for those who want it.
@Twitter
handles.
#JointMeeting2019
@cgknier
@mollyjeffery
@VenkBellamkonda
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Sometimes I just want to write "I just don't know" in the discharge summary
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At a very minimum, practicing medicine teaches you that this world is cruel place
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Stages of grief following a rejected manuscript w/reviewer comments:
Stage 1: WHAT!? What do these people know anyway
Stage 2: OK, I see your point on that one, I'll add to limitations
Stage 3: Hey these were really helpful comments
Stage 4: These reviewers should be coauthors
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Starting 2.5mg of Lisinopril on patient with SBP of 190
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If you want to be successful in academics, be nice. People want to work with nice people.
Smart people are a dime-a-dozen.
*I suspect this applies to every field
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“Your antibiotics are a seasonal blend of Vancomycin and Cefepime-it was a great harvest this year. Your levophed was mixed in a cute little pharmacy just up the road in an environmentally conscious fashion by our local pharmacist, Stefan”
#ArtisanalMedicine
My attending recently told me that I looked like a provider of artisanal Emergency Medicine.
#teamvest
#wool
@concernecus
@mcsassymd
@Filson
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Curious, did anyone's college guidance counselor say 'Yeah, you're a shoo-in for medical school...'?
Because based on what I've read here on Twitter - I'm not sure anyone was ever good enough for this profession
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Every once in a while, your conversation with your mentor should hurt just a little bit. That's the sign that they're pushing you to be better
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This may be a bit unpopular...but I'm going back to shaking my patient's hands
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I am often in awe of
#IMG
physicians and what they have gone through to practice medicine here. May the medical community continue to stand behind these individuals and see the value they bring to our profession and communities
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Junior faculty often wonder how they can grow their local & national stature. My simple take on how you can do it.
What would you add or change?
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Dear academic colleagues,
There is an issue of people feeling bad about leaving an 'Out Of Office' reply on their email, fearing they will be thought lazy. Please don't! You're an adult who needs a break from email & work. I don't judge you & neither should anyone else
Signed,
Me
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Do you know what the most under-sold aspects of being in academics is? Collaboration.
Being able to work/learn from people outside your area of expertise & put together a project or paper that is bigger than you is such an enjoyable experience that isn't talked about enough
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They feel the need…the need for speed.
Introducing Maverick and Goose Wray (they argue over who is who, of course).
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This is pretty accurate. As internists, we basically stand around for 3-4 hours a day and argue about wether we should give fluids or take them away...
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My wife and I are both fairly compensated physicians…
yet she insists on tearing our kids’ napkins in half to “save a little money”.
I love her.
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I think the VA is one of the best health care systems that exists.
At the same time, the closest printer to my office that I can get to work is 2 floors down.
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Anybody else look at a picture of your kids in the middle of the day and want to just leave work, pick them up from school, and take them to a park and play...?
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Just to be clear, as a physician who regularly cares for people with ‘underlying health conditions’ I can attest to the fact that a knee to
#georgefloyd
’s neck is what killed him and not his hypertension. So I went ahead and edited this...
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Recent realization that helped me come to terms with the process:
Academic manuscripts are never done. They just eventually get submitted.
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I am never more academically productive than on an airplane flight.
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For years, I tried to describe what the medical training process, what working for >24 straight hrs is like...Turns out
@mike_natter
figured out how to do it in a 12-panel graphic...
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MGH, JHU, UCSF, etc are fantastic places-especially if you want to be an academic. But the vast majority of docs don’t or won’t. Celebrating these places as the the only place to get a good education does everyone a disservice.
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Just as I sometimes do with my kids, I often ask my medical students/interns questions that I know they know the answer to. You can see them beam with pride when they answer. Makes everyone feel good!
#TipsForNewDocs
@medicalaxioms
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How do you (as an attending) get constructive feedback from your interns & resident? Ask: “what’s something other attendings do that I could incorporate?” (Meta: I learned this from my intern)
@medicalaxioms
@GStetsonMD
@LekshmiMD
@adamcifu
@jeannemfarnan
@tony_breu
@laxswamy
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To be clear, I don’t want to discourage people from sharing, but want to encourage us to create a culture where Community Hospital XYZ is just as good as MGH. Because it is!
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Today I received 2 emails...
One told me of a fundable score on a big grant...
The other was a message from my son's teacher telling me how empathetic and kind of a person he is.
Guess which one I'm more proud of?
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Academic medicine:
When you have an out-of-office reply on and you send an email to someone who also has an out-of-office reply on...yet you're both responding to one another emails within minutes
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12/ No presentation is perfect, but they can always be better. These are just a few techniques I’ve used and seen employed. I would love to hear what you do to overcome the “busy” slide?
Fin
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One of my favorite aspects of inpatient medicine are weekend rounds with the senior resident.
A time when hierarchies melt away and simple conversations about medicine, patients, and life occur...
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I've discovered that there are times in life when you get little done professionally, but a lot done personally.
I count those times as professional wins
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I really worry that when people hear efficacy of 67% of J&J vaccine that they think there is a 33% chance they’ll get COVID-19.
Messaging around this should focus on hospitalization and deaths, which it is 100% effective
Public Heath experts need to be harping on this!
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I still finish entire meals in <5min because of residency...
hi.
It’s me, a PGY-1 on the Friday of a golden weekend who seems to have lost the capacity to relax.
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Really good researchers submit a manuscript when it is perfect, the rest of us submit it when we're tired of staring at it
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Realizing that one of my roles as an educator and academic is to support those more junior than me—so that they can someday surpass me...
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Yep, toiled in training for a solid decade and waited for a pandemic just so I could upcode death certificates for financial gain. You got me, Mr. President...
With record surge of cases in US, hospitalization & deaths rising, Trump accuses doctors of making up
#COVID19
...to make money?!
He’s clearly never filled out a death certificate. Trust us-we fill out too many.
We WILL
#VoteHimOut
#VoteHealth
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This is spot on!
Do all other Hospitalist/internists date themselves by the color of the Pocket Medicine book they used during training?
(I was red)
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I don’t know who needs to hear this, but virtual PE for first graders is a waste of everyone’s time
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IMHO, if you don't tweet out an article you just had published...you've scored a touchdown but chosen not to kick the extra point
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If you want to be a good medical educator, hang out with a toddler. Their incessant ‘whys’ will teach you how to explain complex topics in the most simple manner possible
@medicalaxioms
@FutureDocs
@RyanGamlin
@MDaware
@LekshmiMD
@ShannonMartinMD
@nvhs0401
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It's official. I've completed all the small things on my "to do" list that I was using to prevent me from having to sit down and actually start working on a manuscript I've been perpetually putting off...
@AcademicChatter
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Take a moment. Step back and listen as
@gradydoctor
eloquently describes the struggles of Black Americans during two pandemics
I could have highlighted the whole thing...
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15 years ago tonight, I went out on a limb and gave the cute girl who I was studying a lot with a Valentine’s Day card.
Turned out to be a good bet
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